Objective

Markers of quality of care in various surgical specialties have been shown to correlate with hospital volumes. This study investigates the effect of hospital volume and patient-related factors on the outcomes of children undergoing brain tumor resection.

Methods

We examined the data within the Pediatric Health Information System (PHIS) for children ages 0-17 years undergoing brain tumor resection between 2016-2020. Length of hospital stay (LOS), costs and reoperation rates were analyzed for associations with hospital case-volume, patient factors and other hospital-related factors.

Results

2,568 patients were included in this PHIS analysis. After adjusting for covariates, care provided by high case-volume hospitals led to shorter LOS (p = 0.01). The effect of hospital case-volume on median cost was present on univariate analysis ($63,845 USD at low volume hospital vs $54,909 USD at high volume hospital, p = 0.002), this finding was attenuated by LOS. A trend was observed between reoperation rates and hospital case-volume, with lowest quartile volume hospitals having higher odds of reoperation compared to hospitals with volumes in the highest quartile (p = 0.06). Racial and ethnic minorities, medical comorbidities and other sociodemographic factors were associated with poorer outcomes following surgery.

Conclusions

Centering care around high case-volume hospitals can potentially lead to shorter hospital stays and decreased costs for children with brain tumors. This PHIS manuscript highlights the association of the studied outcomes with certain sociodemographic factors and illustrates that inequalities in pediatric healthcare still exist. Further efforts are required to understand and eliminate these potentially harmful differences.

中文翻译：

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儿科健康信息系统中小儿脑肿瘤手术后的住院病例量和患者结局

客观的

各种外科专科的护理质量指标已被证明与医院数量相关。本研究调查了医院容量和患者相关因素对接受脑肿瘤切除术的儿童结局的影响。

方法

我们检查了儿科健康信息系统 (PHIS) 中 2016 年至 2020 年期间接受脑肿瘤切除术的 0-17 岁儿童的数据。分析住院时间（LOS）、费用和再手术率与住院病例量、患者因素和其他医院相关因素的关系。

结果

2,568 名患者被纳入该 PHIS 分析。在调整协变量后，高病例数医院提供的护理导致更短的 LOS (p = 0.01)。单变量分析显示医院病例数量对中位成本的影响（低容量医院 63,845 美元与高容量医院 54,909 美元，p = 0.002），这一发现因 LOS 而减弱。在再手术率和住院病例量之间观察到趋势，与容量在最高四分位数的医院相比，最低四分位数医院的再手术几率更高（p = 0.06）。种族和少数民族、医学合并症和其他社会人口因素与手术后较差的结果相关。

结论

以高病例量医院为中心的护理可能会缩短住院时间并降低脑肿瘤患儿的成本。这份 PHIS 手稿强调了研究结果与某些社会人口因素之间的关联，并说明儿科医疗保健中的不平等仍然存在。需要进一步努力来理解和消除这些潜在的有害差异。